10B-092 (6) 195 MAIN ST-LEEDS BP-2019-0243
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map.Block: 10B-092 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: ROOF BUILDING PERMIT
Permit# BP-2019-0243
Project JS-2019-000391
Est.Cost:$37400.00
Fee-$266.0 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: JAMES FLANNERY 103061
Lot size(so ft.): 89733.60 Owner: COBB WILLIAM]
Zoning: URB(100)/WP(50)/ Applicant: JAMES FLANNERY
AT. 195 MAIN ST - LEEDS
ApplicantAddress: Phone: Insurance:
1 LOVEFIELD ST (508)294-4052 WC
EASTHAMPTONMA01027 ISSUED ON.812412018 0:00:00
TO PERFORM THE FOLLOWING WORK STRIP & SHINGLE ROOF
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter:
Footings:
Rough: Rough: House# Foundation:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fimplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy sienature:
FeeType• Date Paid: Amount:
Building 8/2420180:00:00 $266.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
�C ew"Koik L Aff U eA T10N *f e00
�
City of Northampton ttamrertAsaalo -
Building Department Cmo OA M OWPemtt
212 Main Street BarMY9ep1s Asepdf -
Room 100 WatrNFM
Northampton, MA 01060 &Itd84daltMl2PinB_
phone 413.587-1246 1
APPLICATION TO CONSTRUCT,ALT REP IR RENOVATE OR SN ONE OR TWO FFAWLY OWELLMG
SECTION 1 •SITE INFORMATION &a- 19 -,�q 3
DEPT OF tiuR WSPEC to be `Tad by
t.T Propeft NOFTHANGTOH.MA01M
Lot 0UMI_
Jg5 rt?c),+N St"r 1J
zone overaY DgMrA
an IN.Swinct CS Ebbkt_
SECTION 2-PROPERTY OWNFRSNWIAUTNORI2EO AGENT..
27 Owner of Racord:
31 Mcf LF�lpn) RD. S TF J, Ao(5tp
Talepham
siamto
2.2 AWhortaid Agate
IRMES 3 GLAtVJJE12'j 1 Lav��'zjc� St �ds� Ate) fah/ Mi_�
Verne(Prinry Carets hft*g Adams: Q)0
yj3 - aos- 58Bg
5kmlure I I v j ITalephomw
SECTION 3 WMATED CONSTRUCTION COATS
itim Estimated Cost(Dollars)to be Official use Ordy
ants scam
i. Building 2 1.1 ob, oa (a)Building Permit Fee
2 Elacaical 7 / (b) `�
3. Plumbing Building ParrMt F" �//
4. Mechanical(HVAC) Y,� If
5.Fes Fmtscim (��
O Check Number
This SsWun ForORfclal Use Onry - ..—..
Dale
Budding Pemfit Number wed:
BuMkgCa w1 mulnw@ctw of ewwngs OeN
p2Alfpfl2foRY)1RNCEROOfIN(,- LLG 6/11Fi%<. enP'j
EMAIL ADDRESS(REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
SECTION 5-DESCRIPTION OF PROPOSED WORN(check all applicable
New None ❑ Addition ❑ RaPlaeemeM Wlndowe I Altwation(e) ❑ Roofing
Or Doom ❑
Accessory Bldg. ❑ Demolition ❑ /New Signs- 0:31 Decks 10 Siding(01 Other ICp
BrieflDescriptionol'Proposed S j ,,,�p 1"Work
Alteration of a sting bedroom_Yes_No Adding new bedroom Yes No
Attached Nermfive Renovating unfinished basement _Yes No
Plans Attached Roll -Sheet
Ba.rIMW 6KM Md Of SAdUM to 811011811110 NOUSDNI.COMOMS OW f611OWiTm:
a. Use of building:One Family Two Family Otho
b. Number of rooms in each family unit: Number of Bathrooms
c. Is there a garage affected?
d. Proposed Square footage of new construction. Dimensions
e. Number of erodes? /
I. Method of healing? 77 Fireplaces or Woodsrovea Number of each
g. Energy Comeation Compliance. M
ryasscheck Energy Compliance form attached?
h. Type ofonnstmction
I. Is construction within 1008 nds?_Yes No. IsooroWcbonwithin100yr. floodplain_Yes_No
j. Depth of basement lar flop balm finished grade
k. Will buildi nform ro the Builtlirp ora Zoning regulations? Yes No.
I. ank_ City Seger_ Private well_ City wants Supply
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR
BUILDING PERMIT
I, V`f IL-�-LAPS` 1 ' 1..6 Y/�-" .as Omer of the subject
pmperty,
he 9by81tl10 bs, JA/hE5 7. FLANA)si2y Dna ARM PSRFORm14NCF 40DOV6 u
to iso off, II mattes relative auttlonud by this building permit application. 1
Siprelue of Ower Date
I,
JAMES J, PLANA)&QY ,asOanenAumoniwd
Agent hereby declare that the statements and information on the foregoing application are We and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
-J,gmES T FLHNN,ERl/
Print Name ! C
6 � O
Signature of OoenAgent v Dale
City of Northampton S Massachusetts
LI�aR1]�rT or BaZI,DiMi ZaePlC4IOHa
212 I . etrwt .M ioipal 9uiidloy
Noevp
itrton, M01060
Debris Disposal Affidavit
In accordance of the provisions of MGL c40, 554, I acknowledge that as a condition of the building
permit all debris resulting from the construction activity governed by this Building Permit shall be disposed
of in a property licensed solid waste disposal facility, as defined by MGL c 111, S 150A.
The debris from construction work being performed at:
l95 md-j&/ 5 �" s
(Please prim house number and street name)
Is to be disposed of at:
(Please prim name and location of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
'amo')rs Rol/-'W/ Z'oomis �y) ' 1;-Of�AAMIPAW m4
(Company Name and Address) D I 0 a
L-1� �/ 1-7-/n
Sign re Permit Applicant or Owner Date
if, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the
Building Department as to the location where the debris will be disposed.
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name IBusinesa/Organiastion/ludividaap: Peak Performance Roofing, LLC
Address: 1 Lovefield St.
City/State/Zip: Easthampton, MA 01027 Phone#: 413-203-5888
A,r�ctyp a an employer?Check the appropriate box: Type of project(required):
1.L�l am a employer with 4 4. ❑ I am a general contractor and I
employees(full and/or part-time).* have hired the sub-contractors 6. E] New construction
2.❑ I am a sole proprietor or partner. listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub-convactors have 8, ❑ Demolition
workingfor me in an capacity, employees and have workers'
Y P tY 9. ❑ Building addition
[No workers' comp. insurance comp. insurance.[
required.] 5. E] We are a corporation and its 10.❑ Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.L] Plumbing repairs or additions
myself. [No workers' camp. right of exemption per MGL 12 IJ Roof repairs
insurance required.]t c. 152,§l(4),and we have no
employees. [No workers' 13.❑ Other
comp. insurance required.]
*Any applicant that cheeks has NI most also fill out the section below showing their workers'compensation policy information.
I flowdownera who submit this affidavit indicating they are doing all work and then hire outside commands must submit a new affidavit indicating such.
tContmcto,s that check this box must attached an additional sheet showing the time of the sub-contractors and state whether or not those entities have
employees. lithe sub-contractors have employees,they must provide their workers wrap.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: Berkshire Hathaway Guard
Policy#or Sclf-ins Li,.#: R2WC943835 Expiration Date: 4/27/2019
Job Site Address: m— m a 4aiOS _City/Stato/Zip: L1 j m74 oioY-3
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. t52 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
1 do hereby certify under the pains and penalties ofperjury that the information provided above is!ru and correct
Sign to -,�_ ]. _ �. Dat �� 0
Phone#: 413-203-5888
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone M
Worker's Compensation and Employer's Liability Policv
11187
rBerkshire Hathaway AmGUARD Insurance Company -A Stock Co.
y Policy Number R2WC943835
,to
GUARD Compan es RenewalNCC No.[21873]
Policy Information Page (AR)
[I]Named Insured and Mailing Address Agency
PEAK PERFORMANCE ROOFING LLC WEBBER&GRINNELL INSURANCE AGENCY, INC.
1 LOVEFIELD STREET 8 NORTH KING STREET
EASTHAMPTON, MA 01027 Northampton, MA 01060
Agency Code: MAMAINI5
Federal Employer's ID 00-1191951 Insured is Limited Liability Co. (LLC)
[2] Policy Period
From April 27, 2018 to April 27, 2019, 12:01 AM, standard time at the insured's mailing address.
[3] Coverage
A. Workers' Compensation Insurance - Part One of this policy applies to the Workers' Compensation
Law of the following states: Massachusetts
B. Employer's Liability Insurance - Part Two of this policy applies to work in each of the states listed
in item [3]A. The limits of our liability under Part Two are:
Bodily Injury by Accident- each accident $100,000
Bodily Injury by Disease- each employee $100,000
Bodily Injury by Disease- policy limit $500,000
C. Refer to Residual Market Limited Other States Insurance WC200306B
Endorsement-
D. This policy includes these endorsements and schedules:
See Extension of Information Page - Schedule of Forms
[4] Premium
The Premium Basis and,therefore,the premium will be determined by our Manual of Rules,
Classifications, Rates, and Rating Plans. All required information is subject to verification and change by
audit. (Continued on another page)
Total Estimated Policy Premium $ 13,650
Total Surcharges/Assessments $ 606.00
Total Estimated Cost 14 256.00
INTFANAL USE xx Page- 1 - Information Page
MGA : R2WC94M35 WC 000001A
Date :04/04/2018
MANOTE
Issuing Office: P.O. Box A-H, 16 S.River Street,Wilkes-same,PA 15703-0020 •www.guard.com
cvAe fa»twosimlet7ld 01C'Waa t7dM4(ae9%
Office of Consumer Affairs and Business Regulation
One Ashburton Place- Suite 1301
Boston, Massachusetts 02108
Home Improvement Contractor Registration
Types LLC
PEAK PERFORMANCE ROOFING,LLC. Re ipiratlm: 11/03
1 LOVEFELD ST. E�ira9an: 11/03/2019
EASTKAMFMN,MA 01027
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P E K Peak Performance Roofing LLC
Contract
P E R F O R C E 1 Lovefield St DataContrad0
Easthampton, MA 01027 g/naols 63s
MA CSW 103061
MA HICa 193698 413-203-5888 peakperformanoeroofingl1oftmail.wm www.peakpMomiencemofmgllawm
Bill To Job Location
Bill Cobb Bill Cobb
195 Main St. 195 Main St.
Leeds,MA 01053 Leeds,MA 01053
rycat46@aol.com ryeat46@ aol.com
860-306-2080 860-306-2080
Description Total
For both the front and back of the shingled slopes: 37,400.00
1.Remove the existing roof shingles.Inspect the sheathing.We will replace up to 100 square feet of plywood if
necessary at no cost.Any additional plywood will be$50 per sheet installed
2.Install Flintlastic SA rolled roofing on low slope roofs
3.Install six feet of ice and water shield at eaves and valleys,12"around roof/wall intersections
4.Cover remaining roof with Certairrteed"Roof Runner"synthetic underlayment
5.Install$"aluminum drip edge on eaves and rake edges
6.Iretall architecture]shingles by Cerminteed -(Landmark PRO)40yr rated
hops d/www.certaintmd.cam/residential-roofingipmductc/Imdmark-pro/
Color Choice: Pewterwood
6.Install ridge vent
7.Complete all necessary flashings including new pipe boots and new base flashing on chimney
Remove all debris from premises,and throughout thejob,continue cleanup and keep the premises undamaged
Total cast:
(Landmark PRO shingles)--$37,400
11,H61C 1/5 D09 I�1F4 xN ,ia aur ��. f� w9tc�e�.
A deposit oft}8,900-is dues at contract signing. T494&^-er�
Deposit Received On: Deposit$ Check 8 too[
*We are not responsible for dirt/dcbris that may fall into attic.Please check for debris after dumpster is removed.' Total:
Contractor Signature: Customer Signature: Date: 1 M
1�
18 $37,400.00
v[ Zo 1-6